Objective assessment of fatigue, sleep and insomnia in breast cancer survivors on estrogen deprivation therapy.
Authors: Lauren A. Fowler, Jamie S. Myers, Shelby Re, Maddie Tedrick, Matthew F. Hudson, Joe Stephenson, Mark Allen O'Rourke
Journal: Journal of Clinical Oncology (2023)

TPS12145 Background: Fatigue, insomnia and sleep problems are common among breast cancer survivors (BCS). These symptoms remain underassessed, underreported and undertreated. Validated and objective measures of sleep metrics have yet to be widely incorporated into BCS studies to help examine the role that these play on patient patient reported fatigue and insomnia. While more than 50% of BCS experience fatigue and insomnia, most research on BCS fatigue is limited to short-term, self-report data that does not objectively assess sleep metrics. Estrogen Deprivation Therapy (EDT) has been shown to exacerbate sleep problems and contribute to perceptions of fatigue and insomnia, yet there is a paucity of research examining the specific effects of EDT on sleep metrics over time, especially objective measures. Wrist actigraphy is a non-invasive, objective measure of rest/activity cycles and sleep via a wrist-worn device. This study utilizes a novel instrument, called Readiwatch (Fatigue Sciences). It is widely validated in the military and in industry but has not been used in patient studies. The Readiwatch assesses fatigue and estimates cognitive performance, based on the Sleep Activity and Task Effectiveness (SAFTE) model developed in conjunction with the Department of Defense in 2004. The Readiwatch syncs with the Fatigue Avoidance Scheduling Tool (FAST) app on the participant’s smartphone to provide a score, called Readiscore, based on previous sleep and activity. It has been shown to have greater than 92% accuracy with lab polysomnography results. The Readiscore also serves as a “cognition” measure that represents the person’s cognitive capacity based on sleep metrics. This novel, objective feedback to the BCS could be very accessible and useful in community medical practice. Methods: This single-center, pilot study of BCS, receiving endocrine therapy, possessing a smartphone and Scoring &gt;8 on the Insomnia Severity Index (ISI), has enrolled 25 of 50 planned participants. Participants wear the Readiwatch for two months to objectively assess their sleep metrics. Patient reported levels of fatigue and insomnia will be assessed prior to, midway, and following the two-month period. Participants document their self-reported experiences through surveys and track their own sleep and fatigue metrics using their smartphone app. At the conclusion of the study participants are provided with personalized feedback about their sleep metrics, along with detailed information related to sleep hygiene. Data analysis will model the effect of actigraphy fatigue measures on reported pain, anxiety, depression, and cognitive impairment and will also examine sleep metrics, perceptions of fatigue and insomnia scores in relation to type of EDT the patient is currently undergoing to determine if there are specific types of adjuvant therapy that are associated with fewer fatigue and insomnia problems.